MOTIVATING HEALTH WORKERS: THE ROLE OF NURSE MENTORING IN LOW-AND MIDDLE-INCOME COUNTRIES

Problem Statement: Poor health worker motivation impedes health care access and provision of quality care in low-and middle-income countries (LMICs). Limited data exist on health worker motivation in India and few appropriate tools are available to generate such data. Objectives: This dissertation aims to systematically review the literature to summarize the scientific evidence on interventions used to motivate health workers in LMICs; to develop a tool to assess nurses’ work motivation in Bihar, India; and to assess the effect of a Mobile Nurse Mentoring (MNMT) intervention on nurses’ work motivation in Bihar, India. Methods: First, a standardized search strategy was employed across five databases. 3,845 titles/abstracts, and 269 full-text articles were reviewed in duplicate and data from those articles meeting the inclusion criteria were extracted. Second, a 24-item self-administered questionnaire, informed by Self-Determination Theory, was adapted to the Bihar context. 320 nurses were sampled and exploratory factor analysis was employed, developing the Nurse Work Motivation Assessment (NWMA) tool. The tool’s internal reliability and construct validity were assessed. Third, the NWMA tool was administered with 317 nurses (157 intervention, 160 control). Multivariable logistic regression models adjusting for socio-demographic and work-related confounders were fitted to explore associations between exposure to MNMT and motivational outcomes. Results: Seven studies have assessed the effect of interventions on motivation: three supervision interventions had a significant positive effect, two compensation and one systems support intervention had no effect, and one compensation intervention had a significant negative effect. The final 15-item NWMA tool produced three subscales capturing theoretical constructs of integrated, worth, and external motivation with good internal reliability and construct validity (except external). MNMT-exposed nurses had a significantly a higher odds of reporting high integrated (OR: 3.17, 95% CI: 1.71 - 5.88, p<0.01) and overall (OR: 1.96, 95% CI: 1.06 - 3.61, p